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Serratus anterior plane block (SPB) as a regional anesthesia technique is used for analgesia in modified radical mastectomy (MRM). The new serratus anterior plane (SAP) block is a novel approach that has been described recently. This study aimed to elucidate the effectiveness and safety of SAP block for pain management after MRM and compare the analgesic effects of SPB and SAP block with those of a control group during the postoperative period of MRM. In a prospective randomized controlled trial, sixty patients (n = 60) who underwent MRM surgery received either SPB or SAP block analgesia. The primary endpoint was the visual analog scale (VAS) score (at rest or with movement) at 2 h after MRM. The secondary outcomes were VAS scores at different time points (6, 12, 24 h) after MRM, stress hormone levels, and the consumption of opioid analgesics during the surgery. Sixty subjects were enrolled. The VAS scores with movement at 2 h postoperation were significantly lower in the SAP group than in the SPB group ( P  = 0.027). The patients in the SAP and SPB groups had lower VAS scores compared with the Control group at 2 and 6 h after MRM, both at rest and with movement ( P  < 0.001). The SPB and SAP blocks significantly reduced the consumption of opioid analgesics during surgery compared with the control group ( P  < 0.001). This study revealed that both SPB and SAP blocks had good postoperative analgesic effects on modified radical mastectomy surgery, reduced the consumption of opioids, and decreased the stress response during surgery compared with the control group. Compared with SPB, the SAP block may have better analgesic effects during the early postoperative period of modified radical mastectomy surgery. Trial registration : This study was registered in the Chinese Clinical Trial Registry (Date of Registration: 08/08/2021, registration number: ChiCTR2100049692).

Simultaneous application of pectoral nerve block and serratus-intercostal plane block (SPB) is one of the most desirable multimodal analgesic strategies, with wide implementation of the enhanced recovery after surgery pathway for modified radical mastectomy (MRM). The aim of the present study was to investigate the efficacy and safety of ultrasound-guided pectoral nerve block I (PECS I) and SPB for postoperative analgesia following MRM. A randomized, prospective study. An academic medical center. A total of 61 women undergoing MRM were randomly divided into 2 groups. The control group (group C, n = 32) received general anesthesia only, whereas the PECS I + SPB treated group (group PS, n = 29) received a combination of pectoral nerve block and SPB in addition to general anesthesia. Pain scores on a visual analog scale, opioid consumption, the duration at the postanesthesia care unit, and the incidence of adverse events were lower in group PS, compared with that of the group C. Moreover, PECS I together with SPB contributed to better sleep quality and higher patient satisfaction of pain relief. This study was limited by its sample size. These results suggest that the combination of PECS I and SPB provide superior perioperative pain relief in breast cancer surgery. Pectoral nerve block, serratus-intercostal plane block, postoperative analgesia, modified radical mastectomy.

IntroductionThe incidence of acute pain subsequent to modified radical mastectomy (MRM) for breast cancer approximates 40%, with more than half of these cases evolving into chronic pain. Currently, the commonly employed analgesic schemes in clinical practice still have inadequacies. Liposomal bupivacaine (LB) is bupivacaine encapsulated in liposomes, and it is reported that its duration of action can extend up to 72 hours. This study will investigate the analgesic efficacy of LB in combination with bupivacaine hydrochloride (BHCl) for transversus thoracic muscle plane (TTP) block and pectoral nerves (PECS) block after MRM for breast cancer.Methods and analysisIn this prospective, randomised, controlled trial, we will enrol 80 female patients aged 30 to 65 years who are scheduled to undergo MRM under general anaesthesia in combination with nerve block. They will be randomly assigned in a 1:1 ratio to the LB+BHCl group (Group A) and the BHCl group (Group B). All patients will undergo ultrasound-guided TTP+PECS block prior to surgery. The primary outcomes are the cumulative pain visual analogue scale (VAS) scores from 6 to 72 hours post-surgery and the quality of recovery, assessed using the QoR-40 score at 72 hours post-surgery. The secondary outcomes include the time to first analgesic rescue, the consumption of analgesic drugs within 72 hours postoperatively, the occurrence of adverse events and the VAS scores at 6 and 12 months postoperatively.Ethics and disseminationEthical approval was obtained from the Ethics Committee of the Affiliated Hospital of Yangzhou University (2024 Ke Lun Shen (2024-07-01)). All patients will provide written informed consent. The results of this study will be published in a peer-reviewed journal.Trial registration numberChinese Clinical Trial Registry (ChiCTR2400089933).

Background Inadequate acute postoperative pain control after modified radical mastectomy (MRM) can compromise pulmonary function. This work aimed to assess the postoperative pulmonary effects of a single-shot thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) in female patients undergoing MRM. Methods This prospective, randomized comparative trial was conducted on 40 female American Society of Anesthesiologists (ASA) II-III, aged 18 to 50 years undergoing MRM under general anesthesia (GA). Patients were divided into two equal groups (20 in each group): Group I received ESPB and Group II received TPVB. Each group received a single shot with 20 ml volume of 0.5% bupivacaine. Results Respiratory function tests showed a comparable decrease in forced vital capacity (FVC) and forced expiratory volume (FEV1) from the baseline in the two groups. Group I had a lower FEV1/FVC ratio than Group II after 6 h. Both groups were comparable regarding duration for the first postoperative analgesic request (P value = 0.088), comparable postoperative analgesic consumption (P value = 0.855), and stable hemodynamics with no reported side effects. Conclusion Both ultrasound guided ESPB and TPVB appeared to be effective in preserving pulmonary function during the first 24 h after MRM. This is thought to be due to their pain-relieving effects, as evidenced by decreased postoperative analgesic consumption and prolonged time to postoperative analgesic request in both groups. ClinicalTrials.gov ID NCT03614091 registration date on 13/7/2018.

Background Although the analgesic effect of erector spinae plane block (ESPB) has been proven, its efficacy may be influenced by the patient’s position during the block. Methods We randomly allocated forty patients undergoing unilateral modified radical mastectomy (MRM) with axillary lymph node dissection to receive preoperative ESPB in sitting (Group 1) or lateral position (Group 2), and the patient was kept in position for 15 min, either in the high Fowler’s or lateral position. The primary outcome was the dermatomal sensory block and radiocontrast material spread by Computed Tomography (CT) 15 min after the block. Secondary outcomes were the visual analog scale for pain (VAS), opioid consumption, patient satisfaction, and complications. Results There was a significant increase in the dermatomal sensory block in Group 1 compared to Group 2 at midaxillary (confidence interval (C.I) 95% = 0.55, p -value = 0.006) and scapular lines (95% C.I  =  0.50, p -value = 0.014); meanwhile, there were insignificant differences at the parasternal and midclavicular lines ( p -value = 0.232 and 0.201 respectively). Early CT showed more craniocaudal contrast distribution in a higher percentage of patients in Group 1, with a higher incidence of spread to paravertebral/epidural spaces (though not statistically significant). The VAS, morphine consumption, and patient satisfaction were comparable. Conclusion The ESPB in the sitting position provided a more significant posterolateral sensory block. The CT evidence of early paravertebral and epidural spread was observed more often in the sitting group, but without statistical significance. ESPB in both patient positions produced comparable postoperative analgesia. Trial registration Pan African Clinical Trials Registry (PACTR) (PACTR202204720116048) on 27/04/2022.

The most common surgical procedure for breast cancer is the modified radical mastectomy (MRM), but it is associated with significant postoperative pain. Regional anesthesia can reduce the stress response associated with surgical trauma. Our aim is to explore the efficacy of 1 µg/kg dexmedetomedine added to an ultrasound (US)-modified pectoral (Pecs) block on postoperative pain and stress response in patients undergoing MRM. A randomized, double-blind, prospective study. An academic medical center. Sixty patients with American Society of Anesthesiologists (ASA) physical status I-II (18-60 years old and weighing 50-90 kg) scheduled for MRM were enrolled and randomly assigned into 2 groups (30 in each) to receive a preoperative US Pecs block with 30 mL of 0.25% bupivacaine only (group 1, bupivacaine group [GB]) or 30 mL of 0.25% bupivacaine plus 1 µg/kg dexmedetomidine (group II, dexmedetomidine group [GD]). The patients were followed-up 48 hours postoperatively for vital signs (heart rate [HR], noninvasive blood pressure [NIBP], respiratory rate [RR], and oxygen saturation [Sao2]), visual analog scale (VAS) scores, time to first request of rescue analgesia, total morphine consumption, and side effects. Serum levels of cortisol and prolactin were assessed at baseline and at 1 and 24 hours postoperatively. A significant reduction in the intraoperative HR, systolic blood pressure (SBP), and diastolic blood pressure (DBP) starting at 30 minutes until 120 minutes in the GD group compared to the GB group (P < 0.05) was observed. The VAS scores showed a statistically significant reduction in the GD group compared to the GB group, which started immediately up until 12 hours postoperatively (P < 0.05). There was a delayed time to first request of analgesia in the GD group (25.4 ± 16.4 hrs) compared to the GB group (17 ± 12 hrs) (P = 0.029), and there was a significant decrease of the total amount of morphine consumption in the GD group (9 + 3.6 mg) compared to the GB group (12 + 3.6 mg) (P = 0.001). There was a significant reduction in the mean serum cortisol and prolactin levels at 1 and 24 hours postoperative in the GD patients compared to the GB patients (P < 0.05). This study was limited by its sample size. The addition of 1 µg/kg dexmedetomidine to an US-modified Pecs block has superior analgesia and more attenuation to stress hormone levels without serious side effects, compared to a regular Pecs block in patients who underwent MRM. Postoperative pain, dexmedetomidine, Pecs block, stress response, breast surgery.

Background Inadequate acute postoperative pain management is linked to the effect on the stress response and development of chronic pain. A unique regional anaesthetic method that is becoming more important for postoperative pain management is erector spinea plane block (ESP). Since its initial description, physicians have questioned weather this novel easy method can take the place of paravertebral block (PVB). Our goal was to evaluate, in contrast to control group, the effects of ESP & PVB on acute and chronic post-mastectomy pain. Methods One hundred and five female patients undergoing modified radical mastectomy participated in this study, randomly allocated into three equal groups: erector spinae plane block (ESP), thoracic paravertebral (TPV), and control groups. Both blocks were ultrasound-guided with 20 ml 0.25% bupivacaine according to patients’ group, control group was administered standard general anaesthesia without intervention. Total morphine consumption in the first 24 h postoperative was the primary outcome. The secondary outcomes were time to the first analgesia, (Visual Analogue Scale)VAS score, serum level of cortisol and prolactin, sedation score, side effects, and LANSS scores in the first, third, and sixth postoperative months were among the variables compared between groups. Results Total morphine consumption in the first 24 h was significantly higher in control than ESP and TPV groups (10.74 ± 1.37, 8.17 ± 1.69, 5.70 ± 1.95 respectively p  < 0.001). Time to first analgesic request was the shortest in control versus ESP and TPV groups as (4.37 ± 3.06, 8.13 ± 1.75, 10.64 ± 1.83 h respectively p ˂0.001). ESP and TPV had significantly lower cortisol and prolactin levels compared to control ( p  < 0.001). The highest LANSS scores were in the control group in the first, third, and sixth months compared with ESP and TPV, with no significant difference between ESP and TPV. Conclusion ESP and TPV blocks provided superior early postoperative analgesia and reduced stress response compared to the control group in female patients undergoing modified radical mastectomy. PVB is better than ESB in acute postoperative pain management (the total morphine consumption VAS score and time of first analgesic request). Both techniques showed better long-term outcomes compared to the control group regarding LANSS score in the 6-month follow-up. Trial registration https://www.ClinicalTrials.gov trial registry (identifier NCT04498234 on 04/08/2020).

Background Nerve blocks are one of the most important methods of postoperative analgesia in breast cancer surgery. We used a randomized controlled clinical trial to compare the effects of rhomboid intercostal nerve block, serratus anterior plane block, and paravertebral block on the quality of recovery and postoperative analgesia in modified radical mastectomy. Methods We used a randomized controlled clinical trial to compare the effects of rhomboid intercostal nerve block, serratus anterior plane block, and paravertebral block on the postoperative quality of recovery and postoperative analgesia in modified radical mastectomy. A total of 132 breast cancer surgery patients were randomized 1:1:1 into three groups. 0.375% ropivacaine 20 ml for ultrasound-guided rhomboid intercostal nerve block group ( n  = 44), serratus anterior plane block group( n  = 44), and paravertebral block group ( n  = 44). The primary outcome was the quality of the recovery-40 questionnaire (QoR-40 score). Results The postoperative 24-hour QoR-40 scores of the rhomboid intercostal nerve block group (median: 186; interquartile range: 177, 190.5) and the paravertebral block group (median: 186.5; interquartile range: 176.25, 190.5) were not statistically significant. The serratus anterior plane block group (median: 168; interquartile range: 163.25, 172) had significantly lower QoR-40 scores than the paravertebral block group (median difference: -17, 95%CI: -20, -13; P  < 0.001). Furthermore, the rhomboid intercostal nerve block group had significantly higher global QoR-40 scores than the serratus anterior plane block group (median difference: 17, 95%CI: 14, 20; P  < 0.001). In addition, the intraoperative sufentanil consumption ( P  < 0.001), number of intraoperative sufentanil users ( P  < 0.001), and postintubation NRS scores ( P  = 0.01) of the rhomboid intercostal nerve block and paravertebral block group were significantly lower than those of the serratus plane block group, but there was no statistically significant difference between the rhomboid intercostal nerve block and paravertebral block group. There was no statistically significant difference between the three groups in postoperative numerical rating scale scores, postoperative tramadol consumption, adverse events, and average length of stay. Conclusion Rhomboid intercostal nerve block and paravertebral block were able to provide similar analgesic effects and QoR-40 scores in breast cancer surgery. However, the blocking effect of the serratus anterior plane block was inferior to the rhomboid intercostal nerve block and paravertebral block. Rhomboid intercostal nerve block may be one of the best alternatives to paravertebral block as a fascial plane block. Trial registry Chinese Clinical Trial Registry ChiCTR2300079196. Registered on 27 December, 2023.

Purpose The objective of this study was to examine the hypothesis that the opioid consumption of patients who receive a rhomboid intercostal block (RIB) or a pectoral nerve (PECS) block after unilateral modified radical mastectomy (MRM) surgery is less than that of patients who receive local anesthetic infiltration. Methods Eighty-one female patients aged 18–70 years who underwent unilateral MRM surgery with general anesthesia were randomly allocated to three groups. The first group received an RIB with 30 ml of 0.25% bupivacaine on completion of the surgery, and the second received a PECS block with the same volume and concentration of local anesthetic. In the third (control) group, local infiltration was applied to the wound site with 30 ml of 0.25% bupivacaine at the end of the surgery. The patients’ total tramadol consumption, quality of recovery (QoR), postoperative pain scores, and sleep quality were evaluated in the first 24 h postoperatively. Results Both the RIB (58.3 ± 22.8 mg) and PECS (68.3 ± 21.2 mg) groups had significantly lower tramadol consumption compared to the control group (92.5 ± 25.6 mg) ( p  < 0.001 and p  = 0.002, respectively). Higher QoR scores were observed in the RIB and PECS groups than the control group at 6 h post-surgery. The lowest pain values were observed in the RIB group. The sleep quality of the patients in the RIB and PECS groups was better than that of the control group ( p  < 0.001). Conclusion Compared to local anesthetic infiltration, the RIB and PECS blocks applied as part of multimodal analgesia in MRM surgery reduced opioid consumption in the first 24 h and improved the quality of recovery in the early period.

Pectoral nerve block type I (PECS I Block) and type II (PECS II Block) with ropivacaine are relatively new analgesic methods for breast-cancer surgery. We evaluated the safety and efficacy of different concentrations of ropivacaine given in the same volume for the PECS II Block in patients undergoing modified radical mastectomy (MRM). One hundred and twenty women undergoing elective MRM who met inclusion criteria were divided randomly into four groups of 30: control group without PECS II Block and R , R , and R groups, who received general anesthesia plus the PECS II Block with ropivacaine at 0.2%, 0.3%, and 0.4%, respectively, in a volume of 40 mL. The postoperative numerical rating scale (NRS) pain score at rest and active was significantly higher in the control group than that in the three ropivacaine groups (P<0.05 for all), and the postoperative NRS score in the R group and R group at 12, 24, and 48 h postoperatively were significantly lower than that in the R group (P<0.05 for all); there was no significant difference between the R group and R group. The time when pain was first felt after MRM, the total number of complaints during 3, 6, 12, 24, and 48 h after MRM, and the total analgesic requirement (tramadol consumption) during the first 24 h postoperatively in the R group and R group were significantly lower than those in the control group and R group (P<0.05 for all); there was no significant difference between the R group and R group. A dose of 0.3% ropivacaine was the optimal concentration for a PECS II Block for patients undergoing MRM because it provided efficacious analgesia during and >48 h after MRM. Increasing the ropivacaine concentration did not improve the analgesia of the PECS II Block significantly.